[A new technique to facilitate donor preparation for DMEK surgery]. / Eine neue Technik zur Optimierung der Spenderpräparation bei der DMEK.

BACKGROUND: Descemet membrane endothelial keratoplasty (DMEK) is becoming more and more the method of choice to treat corneal endothelial diseases in specialized centers. The reasons that prevent this technique from becoming widespread are the delicate donor tissue preparation. By inverting the curvature of the cornea from convex to concave after mounting onto an artificial anterior chamber, we developed a combined manual delamination and hydrodissection technique, which allows a rapid and endothelium-preserving method of separating donor Descemet membranes from the underlying stroma. MATERIAL AND METHODS: Experiments were perfomed with 60 donor corneas that were not suitable for transplantation. Donor age ranged between 42 and 94 years. Two experimental groups were formed: 1 inverse manual delamination (n = 16) and 2 combined manual delamination and hydrodissection (n = 44). All experiments were undertaken by an experienced surgeon who was, however, not experienced with these techniques. We examined the frequency of Descemet membrane rupture as well as the amount of induced endothelial damage (trypan blue staining with quantitative image analysis). RESULTS: Significant lesions of Descemet's membrane that would have led to a loss of the graft occurred in 25% of the manual delamination cases and in 4.5% using the combined technique. Endothelial damage induced by both techniques was low (6 and 5.2%, respectively). CONCLUSION: For DMEK donor preparation, a combination of manual delamination and hydrodissection was shown to be a safe and endothelium-protective technique to separate Descemet membranes from the underlying stroma. A very rapid learning curve for the combination technique is of specific additional interest for beginners in DMEK surgery.

Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty.

PURPOSE: In this retrospective study, the visual outcomes and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the fellow eye were compared. The patient's satisfaction was evaluated. METHODS: A retrospective analysis of 10 patients, who underwent DSAEK in one eye and DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were evaluated, including higher-order aberrations (HOA) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction. RESULTS: Best-corrected visual acuity (BCVA) was significantly better in DMEK when compared with DSAEK (0.16±0.10 vs 0.45±0.58 logMAR, P=0.043). Contrast threshold was significantly higher after DMEK than after DSAEK (0.49±0.23 vs 0.25±0.18, P=0.043). Post-keratoplasty astigmatism, mean spherical equivalent, and HOA did not differ. Nine out of ten patients preferred the DMEK procedure. Visual outcome (4.80±1.14 vs 4.50±1.58, P=0.257), surgery associated pain and burden (DMEK: 1.30±0.48 vs DSAEK: 1.30±0.48, P=1.0), estimated time for recovery and rehabilitation (27.6±54.0 vs 24.9±54.8 days, P=0.173), and mean patient satisfaction (5.40±0.84 vs 5.00±1.05, P=0.257) were evaluated equally. CONCLUSION: Patient satisfaction reached high, equal values after DMEK and after DSAEK. Nevertheless, patients preferred DMEK, if given a choice. Reasons for the preference may include better uncorrected and BCVA, and especially a better contrast sensitivity.

[Endothelial cell loss after retropupillary iris-claw intraocular lens implantation]. / Endothelzellverlust nach retropupillar fixierter Irisklauen-Linse.

BACKGROUND: The aim of this study was to evaluate the indication, visual and refractive outcome, endothelial cell loss and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL). PATIENTS AND METHODS: This retrospective study comprised 62 eyes of 56 patients without adequate capsular support undergoing posterior iris-claw aphakic IOL implantation (Verisyse™/Artisan®) between 2006 and 2012. Mean follow-up was 34 months (range from 13 to 78 months). RESULTS: The IOLs were inserted during primary lens surgery in 11 phakic eyes (17.8 %), during an IOL exchange procedure for dislocated posterior chamber IOLs in 34 eyes (54.8 %), and as a secondary procedure in 17 aphakic eyes (27.4 %). The final best spectacle-corrected visual acuity (BSCVA) in logMAR (mean 0.24 ± 0.45) improved significantly (p < 0.001) compared to the preoperative BSCVA (mean 0.61 ± 0.65). The mean spherical equivalent improved from preoperative 7,25 ± 5,04 diopters (D) (range - 10.25 to + 16.0 D) to - 0.21 ± 1.01 D (range - 4.0 to 3.0 D) postoperatively. Mean central endothelial cell density was 1844 ± 690 cells/mm(2) preoperatively. After surgery mean endothelial cell density decreased statistically not significant with a loss of 5.5 % to 1743 ± 721 cells/mm(2) (p > 0.05) at last follow-up visit. Complications included cystoid macular oedema in 4 eyes (6.4 %), early postoperative hypotony in 2 eyes (3.2 %), pupil ovalisation in 2 eyes (3.2 %), traumatic iris-claw IOL disenclavation in 2 eyes (3.2 %) and spontaneous IOL disenclavation in one eye (1.6 %). CONCLUSIONS: Retropupillar iris-claw IOL provides good visual and refractive outcomes with a low endothelial cell loss and can be used for a wide range of indications in eyes without adequate capsular support.

[Influence of donor lamella thickness on visual acuity after Descemet's stripping automated endothelial keratoplasty (DSAEK)]. / Einfluss der Spenderlamellendicke auf die Sehschärfe nach "Descemet's stripping automated endothelial keratoplasty" (DSAEK).

BACKGROUND: The aim of this study was to evaluate the effect of donor lamella thickness on postoperative visual acuity after Descemet's stripping automated endothelial keratoplasty (DSAEK). MATERIALS AND METHODS: A retrospective analysis of 65 eyes from 61 patients who underwent DSAEK surgery in cases of Fuchs' corneal dystrophy or bullous keratopathy between 2008 and 2011 was performed. The thickness of donor lamella was measured intraoperatively by ultrasonic pachymetry and postoperatively by anterior segment optical coherence tomography (OCT) and correlated to the visual acuity and number of endothelial cells. RESULTS: The donor lamella thickness measured intraoperatively and postoperatively correlated significantly with each other (r = 0.874, p < 0.001). A significant correlation was found between postoperative corneal lamella thickness measured by anterior segment OCT and visual acuity (r = 0.273, p = 0.028) but not between intraoperative donor lamella thickness measured by ultrasonic pachymetry and visual acuity (r = 0.241, p = 0.103). The postoperative endothelial cell number did not show a correlation with either the intraoperatively or the postoperatively measured donor lamella thickness (r = - 0.059, p = 0.731, r = 0.024, p = 0.869, respectively). CONCLUSIONS: Corneal lamella thickness < 120 µm was found to be correlated with a better visual outcome than in cases of thicker corneas > 120 µm. Despite greater difficulty in corneal transplant technique in cases of thinner lamella no increased damage of corneal endothelium was shown. Therefore, DSAEK with corneal lamella thickness < 120 µm is an interesting therapeutic alternative to DMEK.

[Immune reactions to posterior lamellar versus penetrating keratoplasty. A retrospective analysis]. / Immunreaktionen bei hinterer lamellierender vs. perforierender Keratoplastik. Eine retrospektive Analyse.

BACKGROUND: Posterior lamellar keratoplasty is a relatively new surgical procedure for replacing the diseased endothelial layer of the cornea with a healthy layer. There are only few data regarding graft rejection in posterior lamellar keratoplasty. The objective of this paper was to compare posterior lamellar keratoplasty with penetrating keratoplasty for the incidence and risk of graft rejection. METHODS: This retrospective study included a total of 204 consecutive patients who underwent penetrating keratoplasty or posterior lamellar keratoplasty at the Department of Ophthalmology, Charité CVK, between 1999 and 2000 and between 2007 and 2009. Complete data were obtained in 160 cases. Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences), version 12.0. Descriptive statistics, χ(2)-test and mean values were used to describe and assess the data. RESULTS: Out of 160 eyes 29 were treated with posterior lamellar keratoplasty and 131 eyes were treated with penetrating keratoplasty. The incidence of graft rejection was 3.4% in the posterior lamellar group and 29.8% in the penetrating keratoplasty group (χ(2) = 9.02, p < 0.001). Of 44 patients with Fuchs' endothelial dystrophy (FED) 28 underwent posterior lamellar keratoplasty and 16 patients were treated with penetrating keratoplasty. The incidence of graft rejection in this group was 3.6% after posterior lamellar keratoplasty and 18.75% after penetrating keratoplasty. CONCLUSIONS: In this retrospective study with univariate analysis of risk factors, graft rejection was less frequent after posterior lamellar keratoplasty than after penetrating keratoplasty. A comparison of both groups was limited because of different indications for surgery. Posterior lamellar keratoplasty decreased the risk of graft rejection under conditions with the same indications (Fuchs' endothelial dystrophy).

[Early in-the-bag spontaneous intraocular lens dislocation of hydrophilic acryl single piece lenses following uncomplicated phacoemulsification]. / Subluxationsserie eines hydrophilen Kunstlinsentyps nach umkomplizierter Phakoemulsifikation.

BACKGROUND: As techniques for cataract surgery have evolved, spontaneous intraocular lens (IOL) dislocation in patients with no ocular pathology arises less frequently. We present seven consecutive cases of uncomplicated cataract surgery with early in-the-bag spontaneous intraocular lens dislocation for which the same type of hydrophilic single piece lens was used. MATERIAL AND METHODS: A retrospective analysis was conducted on seven cases involving patients with IOL dislocation who underwent uncomplicated cataract surgery within a period of 4 months (October 2010 to January 2011) using the same type of single piece IOL. The median age of the 7 patients was 73 years and IOL repositioning was performed after an average of 10 weeks. RESULTS: Sulcus repositioning could be carried out in only five of the seven patients and IOL repositioning within the capsule was achieved in one patient. A second patient exhibited IOL dislocation after yttrium aluminium garnet (YAG) laser capsulotomy. Explantation of the IOL and sulcus implantation of another IOL type (Acrysof MA50 MB) was necessary for a third patient. A fourth case presented an angled IOL haptic and dislocation of the IOL in the sulcus position. DISCUSSION: Even after uncomplicated cataract surgery, spontaneous in-the-bag IOL dislocation in patients with no ocular pathology may occur due to a hydrophilic lens material which induces stronger anterior capsular phimosis (ACP) in comparison to alternative materials. In combination with a thin lens design this may result in angled IOL haptics and IOL dislocation. CONCLUSIONS: Careful selection of suitable lens design and material according to individual predisposing factors is necessary. This retrospective case study demonstrates that the combination of hydrophilic lens material and a thin lens design may result in early spontaneous IOL dislocation. Furthermore, as established in one case, YAG laser capsulotomy may induce IOL dislocation if the lens design cannot withstand capsular fibrosis.

[Paecilomyces lilacinus keratitis]. / Paecilomyces-lilacinus-Keratitis.

Paecilomyces lilacinus is a rare cause of contact lens-associated keratitis. The infection is difficult to eradicate because of multiple antifungal drug resistance and has a poor outcome. A female patient developed contact lens-associated keratitis and Paecilomyces lilacinus could be demonstrated in the corneal abrasion. Despite antifungal therapy with voriconazole a keratoplasty à chaud was necessary and a poor final visual acuity could not be avoided.

[Complications after cosmetic iris implantation]. / Komplikationen nach kosmetischer Irisimplantation.

We report the case of a 37-year-old patient with ocular complications associated with the implantation of cosmetic iris implants. Implantation of silicone iris implants for the purpose of changing iris colour has been performed since 2004. Diaphragms are implanted in the anterior chamber. Up to now only little information exists about side effects of this method. In the literature severe ocular complications shortly after cosmetic iris implantation are reported in single cases. In our case 5 months after surgery optic nerve damage caused by elevated intraocular pressure (IOP) was diagnosed. Nuclear opacity of both lenses and a decreased number of corneal endothelial cells were observed at the first visit. Because of recurrent IOP elevation despite maximum antiglaucoma therapy, explantation of the iris implants was required. Damage to the trabecular meshwork, opacity of the lenses as well as the reduced number of endothelial cells are permanent and will probably lead to further complications like corneal decompensation and progressing glaucoma.

[Malignant neoplasms of the lacrimal sac: rarity among tear duct diseases]. / Malignome des Saccus lacrimalis : Seltenheit unter den Tränenwegserkrankungen.

BACKGROUND: Malignant neoplasms of the lacrimal sac are rare in the ophthalmic literature, for which there are only very limited diagnostic and therapeutic recommendations. We present five consecutive cases of our hospital from 2006 to 2009. METHOD: Retrospective analysis of all surgically treated patients with lacrimal duct diseases in the years 2006 to 2009, recording of malignant neoplasms and presentation of diagnostic and therapeutic approach. RESULTS: From January 2006 until October 2009 we performed 213 dacryocystorhinostomies at the Eye Clinic, Charité Campus Virchow Klinikum. In five patients intrasaccal malignancies were histologically proven by biopsy. None of the patients showed typical symptoms such as bloody epiphora. In two patients, a squamous cell carcinoma was seen, and one patient showed an adenocarcinoma. The other patients had a lymphoma and a malignant fibrous histiocytoma. The therapeutic approach consisted of surgical resection and radiotherapy. Systemic manifestations did not occur in any of the five patients. In the limited follow-up period no recurrences and no metastases were seen.

[A comparative in vitro analysis of primary and immortalized keratocytes]. / Vergleichende In-vitro-Analyse von primären und immortalisierten Keratozyten.

BACKGROUND: The cultivation of primary keratocytes (HCKp) is difficult and influenced by a multitude of factors. In this study it was examined if immortalized keratocytes (HCKi) can replace HCKp in experiments and be useful in the development of a cornea construct. METHODS: HCKp and HCKi were cultivated and incubated for 72 h with benzalkonium chloride (BAC) or cetrimide at concentrations of 40-0.1 microg/ml or 100-0.01 microg/ml. The vitality and the doubling time (tv) were measured. RESULTS: Treatment with 40 or 4 microg/ml BAC as well as 100 or 10 microg/ml cetrimide led to cell death. The tv was shortened in HCKi especially in cells that were treated with BAC, but only HCKp showed a significant loss of vitality. In cells treated with cetrimide the tv increased significantly in both cell lines and no loss of vitality was detected from 0.1 microg/ml onwards in both cell lines. CONCLUSION: HCKi are more resistant and proliferative than HCKp but they can be used in preliminary experiments as an alternative to primary cells in for example toxicity studies if the detectable differences between the two cell lines, such as the capacity for proliferation and reaction to agents are taken into consideration.

[Meibomian glands : part III. Dysfunction - argument for a discrete disease entity and as an important cause of dry eye]. / Meibom-Drüsen : Teil III: Dysfunktion (MGD) - Plädoyer für ein eigenständiges Krankheitsbild und wichtige Ursache für das trockene Auge.

Meibomian gland dysfunction (MGD), mainly synonymous with posterior blepharitis but typically without prominent inflammatory alterations of the lid margin, is a discrete disease entity and a frequent cause of wetting deficiencies of the ocular surface leading to dry eye disease that deserves increased recognition by clinicians. The history, classification, pathology, influencing factors, diagnostics and therapy are explained and discussed. MGD is mainly based on an obstructive mechanism caused by hyperkeratinization of the excretory duct and/or increased viscosity of the secretion (meibum) with subsequent deficiency of the tear film lipid layer. MGD is influenced by the hormonal status and by chemical and mechanical noxes as well as genetic defects and it occurs more frequently in women and generally increases with age. It results in stasis of meibum inside the glands, dilatation of the ductal system and eventually in atrophy and loss of glandular tissue (gland dropout). Careful investigation of the eyelids and lid margins with eversion, if necessary, should therefore be performed in every case of a wetting defect, notably before fitting contact lenses. Particularly important is the inspection of the meibomian orifices and diagnostic expression by mild mechanical compression of the lid.

[Bioptics with multifocal lenses and Lasek]. / Bioptics mit Multifokallinsen und Lasek.

PURPOSE: Good functional results with multifocal lenses need exact postoperative emmetropia. Therefore, it seems reasonable to perform additional refractive surgery to correct minimal spherical or cylindrical postoperative ametropia (bioptics). But concerns could arise about additional photoptic phenomena or loss of contrast. The literature contains only a few reports about bioptics after multifocal lens implantation. METHOD: In eight eyes of seven patients, laser subepithelial keratomileusis (Lasek) was done after multifocal lens implantation. Pre-Lasek and 6 months postoperatively, we performed the following examinations in addition to visual acuity: contrast sensitivity (Pelli-Robson charts), low-contrast visual acuity (Humphrey AR 570), glare visual acuity (Humphrey AR 570), and night-driving ability (Mesoptometer II, Oculus). RESULTS: Preoperative contrast sensitivity was 1.2-1.65; postoperatively it was 1.35-1.65. Low-contrast visual acuity measured 50-70% preoperatively and 57-70% postoperatively. Glare visual acuity measured 12.5-50% preoperatively and 28.5-57% postoperatively. Mesoptometer measurements did not change after Lasek; they revealed night-driving ability under strict criteria for four patients. CONCLUSIONS: Bioptics as a combination of multifocal lens implantation and Lasek does not cause a functional decline in low-contrast or glare visual acuity, but it minimizes postoperative ametropia. It seems superior to exclusive multifocal lens implantation.

[Significance of cyclosporin A absorption for effective immunomodulatory therapy after high-risk keratoplasty]. / Bedeutung der Cyclosporin-A-Absorption für eine effektive immunmodulatorische Therapie nach Hochrisikokeratoplastik.

AIM: Cyclosporin A (CsA) is applied as an immune modulator in transplantation medicine, including high-risk keratoplasty. We examined the C(0) and C(2)-CsA serum levels after high-risk keratoplasty. The rate of so-called low absorbers was determined, and the importance of low absorption for the survival and rejection freedom of corneal grafts was examined. METHODS: Follow-up of 89 high-risk cornea grafts in the patient group (n=32) ranged from 1 to 72 months postoperatively. The evaluation included data about serum levels of CsA C(0) (24 h after oral CsA application) and C(2) (2 h after oral CsA application) and clinical follow-ups. Using statistical methods, CsA C(0) and C(2) levels and clinical data were examined. Low absorbers did not reach the target C(2) levels by CsA dose adjustment. OUTCOMES: High intraindividual and interindividual variance of CsA C(0) and C(2) values was observed in the examined group of patients. A rate of up to 34.4% (n=11) represented the low absorbers. There was no significance of the low-absorption factor for clear graft survival, rejection freedom, or the rate of side effects observed. An acute endothelial rejection was observed in 23% of grafts and caused 37% of graft failures. In the patients without rheumatic corneal ulcers (n=27), 89% of the corneal grafts remained clear after 12 months, and 52% remained clear after 36 months. CONCLUSIONS: In our study, with a low number of patients and multiple cofactors, the influence of low-absorption CsA on the clear corneal graft survival and rejection rates could not be proved statistically. Due to the specific immune status of the cornea, the influence of low absorption may be lower than in organs such as the kidney and liver. In our study, the C(2) serum level of CsA after high-risk keratoplasty did not provide any helpful information about the prognosis of the corneal grafts or CsA treatment monitoring.

Characterization of Staphylococcus aureus strains isolated from bovine milk in Hungary.

Staphylococcus aureus is a major foodborne pathogen due to its capability to produce a wide range of heat-stable enterotoxins. The primary purpose of this research was to characterize S. aureus isolates recovered from mammary quarter milk of mastitic cows and from bulk tank milk produced on Hungarian dairy farms of different sizes. Macrorestriction analysis of chromosomal DNA from S. aureus isolates was performed using the restriction enzyme SmaI followed by pulsed-field gel electrophoresis (PFGE). The prevalence rates of nine S. aureus enterotoxin genes (sea, seb, sec, sed, see, seg, seh, sei, and sej) and of the toxic shock syndrome toxin 1 gene (tst) were determined by multiplex polymerase chain reaction (PCR). The bulk tank milks of 14 out of 20 farms were contaminated with S. aureus at levels of up to 6.0x10(3 )CFU/ml. Farm size had no significant effect (P>0.05) on the S. aureus counts in bulk milk. The prevalence rates of penicillin resistance were 88.9% and 20.0% among the S. aureus recovered from mastitic quarter milk and bulk tank milk, respectively. After phenotypic characterization, a total of 59 S. aureus isolates were selected for genotyping. PFGE analysis revealed 22 distinct pulsotypes, including 14 main types and 8 subtypes, at a similarity level of 86%. Only one or two main types were observed on each of the farms tested, indicating a lack of genetic diversity among S. aureus isolates within farms, and there were only two pulsotypes which occurred on more than one farm. The PFGE patterns showed genetic relatedness between the S. aureus strains recovered from quarter milk and bulk milk on two large farms, implying that on farms having a high number of mastitic cows, S. aureus from infected udders may contaminate bulk milk and, subsequently, raw milk products. Sixteen (27.1%) of the S. aureus isolates tested by multiplex PCR were found to be positive for enterotoxin genes, with 15 of them carrying just one gene and one strain carrying two genes (seg and sei). The most commonly detected toxin genes were seb, sea, and sec, whereas none of our isolates possessed the see, seh, sej, or tst genes. On 75% of the dairy farms surveyed, no enterotoxigenic staphylococci were recovered from either mastitic quarter milk or bulk tank milk.

[A new posterior chamber intraocular lens for sutureless iris-fixated ciliary sulcus implantation in aphakic eyes without capsular support]. / Neue Hinterkammerlinse zur sulkusgestützten und nahtlos irisfixierten Implantation in aphake Augen ohne Kapselstrukturen.

PURPOSE: To avoid anterior chamber lens implantation in aphakic eyes without capsular or zonular support, the laborious scleral fixation of a standard posterior chamber intraocular lens (IOL) is widely used, despite a large range of possible complications (macular edema, IOL tilt/decentration, suture erosion, vitreous hemorrhage). A sutureless iris-fixed ciliary sulcus implantation of a posterior chamber IOL (Binder-IOL, Fa. Iolution, Itzehoe) designed especially for such cases represents an alternative. METHOD: At the end of both haptics of this IOL, with a 6 mm optic zone, a T-shaped anchor is mounted at an angle of 45 degrees from the optical plane. These anchors are inserted from behind the iris into peripheral iridotomies performed preoperatively with a YAG-laser or intraoperatively with a vitrectomy cutter. The long, C-shaped haptics are thus secured in the ciliary sulcus. RESULTS: After slight modification of the technique, the implantation can be performed securely and reproducibly. In the 22 implantations performed to date, the IOL was well centered and stable, even in cases with only residual iris stroma. If the iridotomies are been performed too centrally, an ovalisation of the pupil may occur. No further side effects have been observed. CONCLUSION: The technique of sutureless sulcus fixation presented here leads to less complications than scleral suture fixation. A prerequisite for safe implantation of the anchors is good visibility of the peripheral iris. The implantation of the Binder-IOL is especially suitable for aphakic eyes with a loosened iris diaphragm.

[Confocal microscopy in corneal dystrophies: a comparison between confocal slit scanning (ConfoScan P2) and laser scanning microscopy (Rostock Cornea Modul-HRT II)]. / Konfokale Scanning-Mikroskopie: Eine vergleichende Darstellung von Hornhautdystrophiebefunden mittels ConfoScanP2 und Rostock Cornea Modul-HRT II.

BACKGROUND: The object of this work was a comparison of confocal images of corneal dystrophies made by a slit scanning microscope versus a laser scanning microscope. MATERIAL AND METHODS: Using the Rostock Cornea Modul-HRT II as a confocal laser scanning microscope the images of five patients with some epithelial, stromal and endothelial corneal dystrophies were acquired. The pictures were compared qualitatively with those taken by the slit scanning microscope "ConfoScan P2" from corresponding pathologies. Also, the images of normal corneas of ten healthy persons were acquired for a qualitative comparison. RESULTS: Confocal images from both devices were able to provide significant helpful diagnostic findings about the corneal microstructure. Essential qualitative differences between the images of both devices used were not observed. Due to the additional hardware components and the software module for image acquisition, analysis and archiving, the RCM-HRT II is favoured over the "ConfoScan P2". Nevertheless, the evaluation in favour of the RCM-HRT II has to be confined because an optimised, user-friendly enhancement, the "ConfoScan 4" is currently available. CONCLUSION: Evaluating corneal dystrophies in vivo, an equivalent utility of both technical approaches has been observed.

[Cystoid macular edema in a pseudophakic patient after several glaucoma procedures. Is local therapy with bimatoprost the reason?]. / Zystoides Makulaödem bei Pseudophakie nach mehreren drucksenkenden Eingriffen. Ist die lokale Medikation von Bimatoprost die Ursache?

BACKGROUND: Prostaglandin-like drugs such as latanoprost (Xalatan), travoprost (Travatan) and bimatoprost (Lumigan) lower the intraocular pressure by improving the outflow of aqueous humor via the uveoscleral pathway. Up to now there is no report about a macular edema after the topical use of Lumigan eye drops in a pseudophakic patient with an intact posterior capsule. PATIENT: A 69-year-old pseudophakic patient with a 14-year history of glaucoma in pseudoexfoliation syndrome, revealed a cystoid macular edema after local treatment with bimatoprost . 6 months earlier a phakoemulsification followed by the insertion of a posterior intraocular lens was performed on the left eye. Due to an elevated intraocular pressure after the surgery, which could not be controlled either by several eyedrops, or by three more operations (one viscocanalostomy with mitomycin c, two cyclophotocoagulations), therefore, a final attempt with bimatoprost (Lumigan) was started. Two weeks later the patient complained of blurred vision, caused by a cystoid macular edema. RESULTS: After discontinuation of bimatoprost and initiation of a local and systemic anti-inflammatory therapy, the edema resolved and visual acuity recovered. CONCLUSION: Bimatoprost (Lumigan) , a synthetic prostamid is similar to human prostaglandins, especially to prostaglandin F (2alpha.) Although it does not bind to the same receptor, its side effects are comparable to those of common prostaglandin analogues. So far there are no reports about the manifestation of a macular edema after using bimatoprost in pseudophakic eyes with an intact posterior capsule. Even if three more operations followed the cataract surgery, we suspect that bimatoprost eyedrops can be held responsible for this. Therefore they should be used with great care and in clear indications, particularly in pseudophakic patients.

Characterization of Listeria monocytogenes isolates from 50 small-scale Austrian cheese factories.

One hundred eighty-one small-scale cheese factories (annual production < 100,000 kg) were tested for the presence of Listeria monocytogenes in cheese and smear samples from 1997 to 2000. In total, 2615 samples were drawn. Fifty (27.6%) of 181 enterprises yielded L. monocytogenes. From 14 of the cheese-making facilities, we obtained more than four L. monocytogenes isolates. A total of 182 mostly cheese- and smear-borne L. monocytogenes strains were characterized by serotyping and pulsed-field gel electrophoresis. In 12 of 14 cheese factories, over half of the L. monocytogenes isolates were genetically indistinguishable by pulsetype. On average, genetically indistinguishable isolates were recovered for 11.9 months. Regarding serotypes, 27.3% of the isolates were of serovar 4b. Inadequate personal hygiene could explain the high prevalence of serovar 4b isolates in small-scale cheesemaking facilities. Forty-two percent of the serovar 4b isolates recovered from epidemiologically unlinked facilities (in comparison to 40 and 29% of the 1/2a and 1/2b isolates, respectively) were genetically indistinguishable from at least one other isolate. Indistinguishable serovar 1/2a and 1/2b isolates belonged to five and six different pulsetypes, respectively, whereas serovar 4b isolates belonged to only two pulsetypes. This finding suggested a wide distribution of genetically homologous serovar 4b isolates among the facilities tested in our study.

[Reconstruction of skin defects in the eyelid and periorbital region using four triangular advancement flaps. An alternative to free skin grafts]. / Rekonstruktion von Hautdefekten in der Lid- und Periorbitalregion mittels vier Dreiecksverschiebelappen. Eine Alternative zum freien Hauttransplantat.

PURPOSE: This report presents a procedure as an alternative to free skin grafts for reconstruction of rhomboid skin defects in the lid region. METHOD: Ten consecutively treated patients were included who had skin defects after resection of eyelid tumors such as basaliomas. The skin defects were rhomboid and had the same horizontal and vertical diameter (medium 1.5 cm) and were therefore too large for a horizontal advancement flap. The defects were closed by preparation of four triangular skin flaps that were sutured crosswise into the defect. RESULTS: The procedure was adequate for reconstruction of the defect in all ten cases. There were no lid malpositions and the cosmetic results were favorable in all cases. The medium operation time was significantly shorter in comparison to free skin grafts. CONCLUSIONS: Application of free skin grafts is a standard procedure for reconstruction of anterior lamellar lid defects. Triangular transposition flaps can be a timesaving alternative with good cosmetic results.